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Biomedical subjects

G T Tindall

Publications and source records attributed to G T Tindall.

At least 91 records · Page 5Linked to original sources
PubMed1977

Concentration of 3',5' cyclic adenosine monophosphate in ventricular CSF of patients following severe head trauma.

Previous studies have demonstrated that cerebrospinal fluid (CSF) from the lateral ventricle of patients without disturbance of sensorium or intracranial pressure, contains 15 to 30 nM 3',5' cyclic adenosine monophosphate (cAMP). The concentration of this cyclic nucleotide was measured by radioimmunoassay in 133 samples of CSF from the lateral ventricle of 26 patients who were comatose following acute head trauma for periods up to 40 days. Concentration of CSF cAMP in diminishing coma Grades V, IV, III, II, and I was 1.5 +/- 0.1 nM; 1.24 +/- 0.34 nM; 3.14 +/- 0.7 NM; 10.06 +/- 3.47 nM; and 13.36 +/- 1.38 nM, respectively. After the sensorium cleared (coma Grade 0), cAMP was 22.0 +/- 1.7 nM. The correlation between the grade of coma and cAMP concentration was -0.80 (p greater than 0.01). These results imply that alteration in the level of consciousness following head trauma is associated with a disturbance of cAMP metabolism within the central nervous system. Possible mechanisms explaining this observation as well as therapeutic implications are discussed.

Adolescent↗
PubMed1977

Pain relief in metastatic cancer other than breast and prostate gland following transsphenoidal hypophysectomy. A preliminary report.

Hypophysectomy was performed in six patients with advanced carcinoma other than from breast and prostate gland to alleviate pain. Two patients received significant and lasting relief of pain; one achieved relief but died from progression of disease 5 weeks after surgery; one patient, initially relieved, had recurrence of pain 3 months later; one had about 50% relief; and one received no benefit. Possible mechanisms for pain relief include changes in pituitary hormones, prostaglandins, and the newly isolated brain peptides, alpha and beta endorphin. These preliminary observations will require further critical evaluation in a larger series to determine the effectiveness of hypophysectomy in relieving pain in cancer other than from the breast and prostate. The results, nevertheless, do imply that a different approach to pain, namely endocrine manipulation, may be beneficial in certain cancer patients.

Adult↗
PubMed1977

Transoral, transsphenoidal microsurgical exposure of the pituitary gland and infundibulum in the rhesus monkey. Description of operative technique.

A transoral, transsphenoidal microsurgical technique for exposing the pituitary stalk and gland of the rhesus monkey is described and illustrated. The technique has proved to be a safe and practical method for performing a variety of pituitary operations in a total of 37 animals. The procedures have included complete hypophysectomy, posterior lobe resection, pituitary stalk section, collection of portal venous blood, collection of pituitary venous blood, and placement of lessions in the organum vasculosum of the lamina terminalis.

Animals↗
PubMed1977

Aminophylline and isoproterenol in the treatment of cerebral vasopasm.

Eighteen patients with cerebral vasospasm following subarachnoid hemorrhage were treated with 21 trials of intravenous aminophylline and isoproterenol. After angiographic demonstration of spasm, all patients were started on a continuous intravenous infusion of aminophylline 125 mg/hr and isoproterenol 125 micrograms/hr, preferably for a period of at least five days before the medications were tapered. Of the 21 treatment trials, there were 11 definite beneficial responses and ten failures. This study emphasizes the importance of instituting this therapy as rapidly as possible following the confirmation of symptomatic cerebral vasospasm. In addition, if a response occurs it will be noted within 24 hours of institution of the medications. If no response is noted following this time period, the medications should be discontinued. The major complications of this therapy include hypotension, tachycardia and arrythmias. These complications may necessitate diminishing the dosage of the medications. However, if a response has been obtained, every effort should be made to avoid discontinuing therapy prematurely since cerebral vasospasm may recur. The use of isoproterenol and aminophylline is based on their demonstrated ability to increase cyclic adenosine monophosphate (cyclic AMP) levels in vascular smooth muscle, thus producing relaxation of vasospasm.

Adolescent↗
PubMed1976

Complications of surgery for subdural hematoma.

In this report we have discussed the complications of surgery for subdural hematoma. The complications are varied and many depend primarily on the type of treatment required by the patient. We have considered the problems associated with: percutaneous tap in infants, subdural shunts in infants and children, craniotomy for membranectomy, twist-drill drainage, and burr holes, craneictomy, and/or craniotomy. Infection, epilepsy, and reaccumulation of the subdural hematoma are common to all forms of therapy, while other complications are related to the specific form of subdural hematoma treatment. In addition, significant serum and electrolyte abnormalities which may occur as a consequence of subdural hematoma surgery have been reviewed. In general, the over-all complication rate of surgery for subdural hematoma is low in relationship to the morbidity and mortality associated with this lesion. Because of the frequency of subdural hematoma, the neurosurgeon should be ever vigilant in the prevention, recognition, and management of these complications.

Acute Disease↗
PubMed1976

Hypophysectomy in the treatment of disseminated carcinoma of the breast and prostate gland.

Transsphenoidal hypophysectomy offers gratifying palliative relief of pain to patients with metastatic cancer of the breast and prostate. This report represents the results of two years' experience with this procedure at Emory University School of Medicine. The physiologic rationale and clinical indications for hypophysectomy are described, as is the operative technic using the open transsphenoidal microsurgical approach. The series of cases reported here includes 20 men with disseminated prostatic carcinoma and 23 women and one man with metastatic carcinoma of the breast. All 44 procedures were done by the transsphenoidal microsurgical approach. Pain was the preoperative indication for surgery in 41, while three patients were operated on for extensive disease without pain. Satisfactory relief of pain was obtained in 76% of the patients with prostatic cancer and in 83% of the breast cancer patients. While the results are gratifying with regard to relief of pain, the duration of follow-up is not sufficient to comment on the value of the procedure in significantly prolonging life.

Adult↗
PubMed1976

Effects of hyperventilation, CO2, and CSF pressure on internal carotid blood flow in the baboon.

The combined effect upon cerebral blood flow (CBF) of an elevation of cerebrospinal fluid pressure (CSFP) and changes in respiratory CO2 was studied in nine baboons under chloralose anesthesia. The animals were mildly hyperventilated and provided with increasing amounts of CO2 in O2-air. Arterial CO2 tensions (PaCO2) increased from 17 to 58 mm Hg. Internal carotid blood flow (ICBF) was measured at normal CSFP and at hydrostatically maintained 50 mm Hg CSFP. It was found that: 1) end-tidal CO2 may be used as a substitute for arterial PaCO2 determinations; 2) this elevation of CSFP has little effect on ICBF during hypercapnia and normocapnia; however, 3) during hypocapnia the ICBF is reduced an additional 20% when CSFP is elevated; that is, ICBF is reduced 50% from normal when end-tidal CO2 is reduced to 2% at this elevated level of CSFP. Caution should be exercised during hyperventilation therapy particularly if the elevated CSFP or intracranial pressure (ICP) is not reduced to approach normal levels; in these conditions, the combination of decreasing PaCO2 and elevated ICP may reduce CBF below critical levels and thus lead to cerebral hypoxia.

Animals↗
PubMed1976

Continuous monitoring of intracranial pressure in severe closed head injury without mass lesions.

Intracranial pressure (ICP) was monitored continuously for up to two weeks in 40 patients with severe closed head injury with no angiographic evidence of mass lesion. Two-thirds of these patients had normal pressure. The results indicated that there is a lack of correlation between clinical presentation and ICP. Reliable prognostic factors include clinical evidence of brain stem dysfunction and age, but not intracranial pressure. From the data we have concluded that the clinical value of ICP monitoring in this type of head injury is uncertain.

Adult↗
PubMed1975

Monitoring of patients with head injuries.

A practical protocol for evaluating and monitoring head injured patients has been presented. It has been stressed that monitoring is an ongoing process which begins with the initial evaluation and continues throughout the patient's hospital stay. The level of monitoring and thus the parameters to be monitored are determined on an individualized basis according to the patient's clinical status and his level of stupor and coma. It has been suggested that for mild head injuries, adequate monitoring includes periodic evaluation of the neurological status and vital signs; but the more severely injured patients require extensive and frequent monitoring of a large number of clinical and physiological parameters. Among the many parameters, the continuous monitoring of ICP and the respiratory system are perhaps the most useful indicators of the patient's condition. Several methods for continuous ICP monitoring which are readily adaptable to most neurosurgical practices have been discussed. These include the intraventricular catheter, subarachnoid screw, and the closed Rickham reservoir connected to a ventricular catheter. In our institution, the Rickham reservoir has been used to monitor ICP and at the time of this report, satisfactory ICP recordings have been obtained in 27 of 30 head injury patients. Although this method requires a small surgical procedure, we believe that the decreased incidence of infection, the rapid access to ventricular fluid, and its potential for long term monitoring justify its use. Suggestions for monitoring other physiological parameters have also been presented. Particular emphasis has been placed on the management of infants and children with head injuries. The clinical entity of chronic subdural hematoma in infants and children has been used to illustrate the value of ICP monitoring as a guide to further treatment. Finally, we have briefly discussed the place of computers in day to day patient care, research, and monitoring.

Blood Pressure↗
PubMed1975

Cardiorespiratory changes associated with intracranial pressure waves: Evaluation of these changes in 27 patients with head injuries.

Alteration in heart rate and respiratory rate and depth occurred in association with intracranial pressure (ICP) waves in 27 patients with head injuries. Usually the ICP wave was preceded by a transient increase in end-alveolar CO2 levels. Thereafter, the ICP gradually increased and was accompanied by simultaneous decreases in heart rate and respiratory rate and depth. Immediately before the termination of the ICP wave, there was an abrupt increase in heart rate and respiratory rate and depth. After the ICP fell to base line level, heart rate and respiratory returned to control values. It is suggested that the transient alterations in the CO2 level at the beginning and during the ICP wave probably initiate these abnormal waves. While the heart rate changes are striking, their role in the formation and termination of ICP pressure waves is uncertain.

Adolescent↗
PubMed1975

Monitoring intraventricular pressure using an implanted reservoir in head injured patients.

Intracranial pressure monitoring facilitates the management of patients with severe craniocerebral trauma. The advantages of monitoring from the intraventricular space are outweighed by the increased incidence of infections with this technique. A system using an implanted Rickham reservoir attached to an intraventricular catheter with exchangeable external connections has been used successfully for monitoring intracranial pressure in 34 of 35 consecutive head-injured patients, with one minor infection.

Catheterization↗
PubMed1975

Cerebral aneurysms of traumatic origin.

This report reviews 41 cases of traumatic cerebral aneurysms, including four cases of our own which are presented in detail. They may follow penetrating or closed head injury, and are usually associated with significant additional intracranial damage. Almost half of the patients presented with a delayed subarachnoid hemorrhage within three weeks of the initial head injury, defining an important neurological syndrome. Those patients whose post-traumatic aneurysms have been surgically obliterated have an associated mortality which is half that of patients treated by nonsurgical methods.

Adult↗